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Abstract

Resumen Antecedentes y objetivo Evaluar el malestar emocional y el nivel de complejidad de pacientes presentados al Comité de Atención Psicosocial. Materiales y métodos Estudio pre-post con un solo grupo en pacientes con cáncer. De los 144 pacientes, 27 fueron derivados por el comité a especialistas del área psicosocial, y sus niveles de malestar emocional y de complejidad fueron revisados un mes después. Resultados Tras ser atendidos según indicaciones del comité, los pacientes mostraron un descenso significativo de los valores en malestar emocional: la media inicial de 8 puntos en la escala visual analógica de malestar emocional descendía a 5,8 puntos. El descenso se reflejó también en los niveles de complejidad: antes de ser revisados, el 70,4% de los pacientes mostraban un alto nivel de complejidad y el 7,4%, un nivel bajo. Después de ser atendidos, los porcentajes de pacientes con alta complejidad se redujeron al 48,1% en los enfermos con alta complejidad, y aumentaron al 22,3% en los de baja complejidad. Conclusiones El comité ofrece un instrumento para derivar los casos de mayor complejidad que requieren atención preferente y multidisciplinar, permitiendo optimizar recursos, por su eficacia en la resolución de casos complejos.

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... Cada tipología de enfermedad tiene sus «momentos» en los que es más fácil que emerja. En cáncer: en la primera recaída y la derivación a paliativos; en insuficiencia de órgano: en la crisis aguda; en patología neurológica: ante la dependencia y la necesidad de alimentación o respiración artificial; en fragilidad: ante el traslado a residencia y la pérdida de relaciones [5][6][7] . El DAM se ha relacionado con múltiples variables, como el malestar físico y la dependencia funcional 8 , el malestar psicoemocional (depresión, síndrome de desmoralización, angustia emocional y malestar existencial: pérdida de sentido, de control y de dignidad percibida) 9 y el malestar sociofamiliar (sentirse una carga) 7,10 . ...
... El DAM es un fenómeno cambiante, que puede emerger en cualquier momento de la evolución de la enfermedad y de las necesidades (26,33,34) , y puede obedecer a distintos desencadenantes según el tipo de enfermedad. Así en cáncer los desencadenantes de la aparición de DAM son la primera recaída y la derivación a paliativos; en insuficiencia de órgano, la crisis aguda; en patología neurológica, la dependencia y la necesidad de alimentación o respiración artificial; y en fragilidad, el traslado a residencia y la pérdida de relaciones (8) . ...
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Objective: The wish to hasten death has been little researched in the area of Mediterranean countries and we are not aware of specific studies on its particularities in home care in our setting. The aim of this work was to investigate the prevalence and evolution of wish to hasten death in home care, analysing its relationship with physical, emotional, spiritual, ethical and social-family unrest. Methods: Longitudinal observational study in palliative home care in Catalonia. 43 teams agreed on the level of complexity after the first visit and after the discharge of the patient with the HexCom model, which classifies the desire to anticipate death into Low complexity (no or sporadic manifestation); Medium (persistent desire that requires specific treatment); or High (persistent desire that is considered potentially refractory). For the comparison of proportions, Pearson's Chi-squared test was used and a multivariate logistic regression analysis was performed, in which the dependent variable corresponded to the desire to hasten initial death. The level of significance was p≤0.05. Results: The total number of patients included in this study was 1,677, of whom 1,169 (69.7%) were oncologic. The prevalence of desire to hasten death was 6.67%. It was related to spiritual distress, especially lack of meaning (OR 3.25) and lack of connection (OR 3.81), to psychoemotional distress (OR 2.34) and to ethical distress. Protective factors were spiritual distress in relation to transcendence (OR 0.50), the caregiver being a partner (OR 0.50) and being cared for by a team that included psychology and social work (OR 0.34). The desire to anticipate death is stable in 71.6% of patients. Conclusions: The desire to anticipate death is a changing and complex phenomenon that can emerge at any time. The presence of psycho-emotional, spiritual-existential and ethical discomfort, especially in patients without a partner, should make us take a proactive attitude to identify it early.
... Esto significa que la complejidad va más allá de las necesidades de los dominios físicos, psicológicos, sociales y espirituales, y que incluye cómo los pacientes interactúan con la familia y los profesionales, y cómo los servicios responden a estas necesidades 3 . Por otra parte, sabemos que la complejidad viene profundamente influida por la naturaleza dinámica de la enfermedad y de las necesidades a lo largo del tiempo [4][5][6] . Aunque hay bastante información de las diferentes trayectorias en cuanto a las enfermedades específicas, a las necesidades y a las experiencias de enfermos y familiares 7,8 , no conocemos estudios sobre la trayectoria de la complejidad. ...
... Health professionals forming a Psychosocial Committee meet weekly to make decisions about the needs and care of the most complex cancer cases. This model is a pioneering way of providing comprehensive care to patients and their families, and has shown promising results in efficacy and effectiveness, as prioritizing the most complex cases could help optimize the use of health resources (Gil et al., 2019). ...
Article
Objective Cancer is one of the biggest health challenges of our times, affecting all the personal areas of a patient. The interrelationships between these areas and the need for multidisciplinary care require the assessment of psychosocial complexity in cancer patients. The main aim of this study was to reach a consensus on the general definition of psychosocial complexity in cancer and its main elements according to the experts in the field. Method A Delphi study was performed, which first involved a comprehensive review of the literature to create a questionnaire that was validated by two expert panels. The first panel consisted of intra-institutional experts, while the second included extra-institutional experts in the field. The study included three more rounds: (1) validation of the questionnaire by the internal panel, (2) discussion of the results and resolving discrepancies, and (3) validation of the questionnaire by the external panel. Results After the four-round Delphi process, we obtained a consensus definition of psychosocial complexity in cancer patients, as well as of its main factors: medical–physical, social-family, psychological, and spiritual. A 21-indicators list and its 8-indicators brief version were also proposed as indicators of psychosocial complexity. Significance of results We present a definition of psychosocial complexity in cancer patients that has been agreed by experts, also establishing its four factors: medical–physical, social-family, psychological, and spiritual. This has led to the development of a list of indicators (and its brief version) that, after a validation process, could help health professionals to identify patients with high psychosocial complexity to provide them an optimal care.
... He leído con atención el artículo publicado recientemente por F.L. Gil Moncayo et al. 1 sobre la complejidad del abordaje psicosocial en pacientes con cáncer. Debido al interés que me ha generado el tema en cuestión me gustaría aportar alguna sugerencia sobre el mismo. ...
Article
Background Patients with hematological malignancies receiving hematopoietic cell transplantation (HCT) or chimeric antigen receptor (CAR) T-cell therapy are at risk of developing serious clinical complications after discharge. Objective The aim of the TEL-HEMATO study was to improve our telehealth platform for the follow-up of patients undergoing HCT or CAR T-cell therapy during the first 3 months after discharge with the addition of wearable devices. Methods Eleven patients who received autologous (n=2) or allogeneic (n=5) HCT or CAR T-cell therapy (n=4) for hematological malignancies were screened from November 2022 to July 2023. Two patients discontinued the study after enrollment. The telehealth platform consisted of the daily collection of vital signs, physical symptoms, and quality of life assessment up to 3 months after hospital discharge. Each patient received a clinically validated smartwatch (ScanWatch) and a digital thermometer, and a dedicated smartphone app was used to collect these data. Daily revision of the data was performed through a web-based platform by a hematologist or a nurse specialized in HCT and CAR T-cell therapy. Results Vital signs measured through ScanWatch were successfully collected with medium/high adherence: heart rate was recorded in 8/9 (89%) patients, oxygen saturation and daily steps were recorded in 9/9 (100%) patients, and sleeping hours were recorded in 7/9 (78%) patients. However, temperature recorded manually by the patients was associated with lower compliance, which was recorded in 5/9 (55%) patients. Overall, 5/9 (55%) patients reported clinical symptoms in the app. Quality of life assessment was completed by 8/9 (89%) patients at study enrollment, which decreased to 3/9 (33%) at the end of the third month. Usability was considered acceptable through ratings provided on the System Usability Scale. However, technological issues were reported by the patients. Conclusions While the addition of wearable devices to a telehealth clinical platform could have potentially synergic benefits for HCT and CAR T-cell therapy patient monitoring, noncomplete automation of the platform and the absence of a dedicated telemedicine team still represent major limitations to be overcome. This is especially true in our real-life setting where the target population generally comprises patients of older age with a low digital education level.
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RESUMEN Introducción. El cáncer, implica grandes niveles de estrés derivado de toda la problemática para su atención y cuidado, especialmente si son los hijos quienes lo padecen; es una de las principales causas mundiales de morbimortalidad entre la población que aún no tiene 20 años de edad. Objetivo. Precisar el malestar psicosococial, según el tiempo transcurrido en el proceso oncológico, revisado a través de niveles de ansiedad y depresión, así como las estrategias de afrontamiento dominantes, en cuidadores primarios de menores en tratamiento de cáncer atendidos en un centro de cancerología de Nayarit, México. Materiales y Métodos. Se realizó un estudio descriptivo y transversal, con muestreo incidental; se aplicó a 42 cuidadoras primarias de niños con cáncer la Escala de Ansiedad y Depresión Hospitalaria y Cuestionario de Afrontamiento al Estrés. Resultados. De la muestra, el 88 por ciento, registró síntomas clínicos de depresión y el 67 por ciento de ansiedad. La diferencia de porcentaje entre grupos según el tiempo de cuidado indica que, al inicio del tratamiento este malestar es más agudo. La focalización en solución de problemas es la estrategia más utilizada, seguida por reevaluación positiva y autofocalización negativa. Se encontró asociación negativa entre depresión y evitación (rho=-.325). Conclusión. Se identifican en cuidadoras procesos de malestar emocional y necesidades de comunicación con equipo tratante, según fases de enfermedad, por lo que es necesario crear protocolos de acuerdo con cada contexto, problemática, recursos del paciente y su familia, para la atención integral psicooncológica. Palabras clave: Afrontamiento, cuidadoras primarias, malestar psicológico. Ibn Sina-Revista electrónica semestral en Ciencias de la Salud agosto de 2022. Volumen 13, Número 2-Web: http://revistas.uaz.edu.mx/index.php/ibnsina 2 ABSTRACT Introduction. Cancer implies high levels of stress derived from the attention and care needed, especially if the
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Background/Objective Cancer can be extremely disruptive, triggering high levels of distress, and at the same time transformative, promoting perceptions of positive life changes and growth. This study aims to analyze the psychometric proprieties of the Stress-Related Growth Scale Short-Form (SRGS-SF) in cancer patients. Method 209 Cancer patients heterogeneous in disease stage and diagnosis completed: clinical and sociodemographic information, Distress Thermometer, Positive and Negative Affect Schedule, Visual-analogue Scale of Perceived Positive Life Changes, and Stress-Related Growth Scale-Short Form. Results The analysis of internal structure pointed to an one-dimensional scale, with high reliability (.92) measured through the McDonald`s omega coefficient. Validity was also evidenced through significant correlations with other variables. Conclusions The Portuguese version of the SRGS-SF seems to present the necessary psychometric proprieties to be considered a valid and reliable short tool, to assess perceptions of growth following cancer and contribute to targeted and integrative psycho-oncological interventions.
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Objective Why some people recover emotionally after diagnosis and treatment of cancer and others do not is poorly understood. To identify factors around the time of diagnosis that predict longer-term distress is a necessary step in developing interventions to reduce patients' vulnerability. This review identified the demographic, clinical, social, and psychological factors available at or within 3 months of diagnosis that are reliable predictors of emotional distress at least 12 months later. Methods A systematic search of literature for prospective studies addressing our research question and predicting a range of distress outcomes was conducted. Thirty-nine papers (reporting 36 studies) were subjected to narrative synthesis of the evidence. Results There was no consistent evidence that demographic, clinical, or social factors reliably predicted longer-term distress. Of the psychological factors examined, only baseline distress (significant in 26 of 30 relevant papers; 24 of 28 studies) and neuroticism (significant in all 5 papers/studies that examined it) consistently predicted longer-term distress. The heterogeneity of included studies, particularly in populations studied and methodology, precluded meta-analytic techniques. Conclusions This review supports current clinical guidance advising early assessment of distress as a marker of vulnerability to persistent problems. Additionally, neuroticism is also indicated as a useful marker of vulnerability. However, the review also highlights that more sophisticated research designs, capable of identifying the psychological processes that underlie the association between these marker variables and persistent distress, are needed before more effective early interventions can be developed.
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Cancer is a devastating disease causing significant psychological problems among patients and their families. In the past few decades, there have been growing implementation and dissemination of screening methods for the psychological consequences of cancer, including distress, depression, anxiety, post-traumatic stress, and demoralisation. Also, guidelines for the management of psychological distress have been developed and endorsed by a number of scientific cancer associations. This review examines some of the most significant related issues, also focusing on recent advances in psychosocial and psychopharmacological interventions as a part of a mandatory, integrated, and comprehensive approach to cancer care.
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In 2015, the World Health Organization (WHO) Demonstration Project on Palliative Care in Catalonia (Spain) celebrated its 25th anniversary. The present report describes the achievements and progress made through this project. Numerous innovations have been made with regard to the palliative care model, organization, and policy. As the concept of palliative care has expanded to include individuals with advanced chronic conditions, new needs in diverse domains have been identified. The WHO Resolution on "Strengthening of palliative care as a component of comprehensive care throughout the life course," together with other related WHO initiatives, support the development of a person-centered integrated care palliative care model with universal coverage. The Catalan Department of Health, together with key institutions, developed a new program in the year 2011 to promote comprehensive and integrated palliative care approach strategies for individuals with advanced chronic conditions. The program included epidemiological research to describe the population with progressive and life-limiting illnesses. One key outcome was the development of a specific tool (NECPAL CCOMS-ICO©) to identify individuals in the community in need of palliative care. Other innovations to emerge from this project to improve palliative care provision include the development of the essential needs approach and integrated models across care settings. Several educational and research programs have been undertaken to complement the process. These results illustrate how a palliative care program can respond and adapt to emerging needs and demands. The success of the palliative care approach described here supports more widespread adoption by other key care programs, particularly chronic care programs.
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Main messages • Differences in cancer outcomes among EU countries are related to differences in prevention policy, screening, access to specialised care, availability of innovative treatments and organisation of cancer care provision. • The EPAAC sub-project on Healthcare explored networks for their innovative and efficient manner of organising the patient journey at regional, national and EU level. Networks facilitate multidisciplinary cancer care and rapid access to accurate diagnosis and treatment of cancer. • EPAAC identified key challenges to the network approach, including the need to balance organisational innovation with continuity of care and stability, as well as the integration with primary health care and patient involvement in network management. • Our experience shows that specialised, high-quality care of rare cancers has a European dimension, which can be explored through a network model supported by evidence-based clinical guidelines, clinical expertise, a multidisciplinary approach and evaluation of outcomes.
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In this article, we aim to (a) identify distinct trajectories of psychological distress in the first year after a breast cancer diagnosis in women treated with adjuvant therapy and (b) explore possible predictors of these trajectories, that is, demographic, medical, and personal characteristics. The 171 patients were assessed after diagnosis, after surgery, after adjuvant treatment, in the reentry phase, and in the (short-term) survivorship phase (2 and 6 months after the end of treatment, respectively). Psychological distress was assessed with the 12-item General Health Questionnaire. There were four trajectories of distress: a group that experienced no distress (36.3%), a group that experienced distress only in the active treatment phase (33.3%), a group that experienced distress in the reentry and survivorship phase (15.2%), and a group that experienced chronic distress (15.2%). Personality and physical complaints resulting from adjuvant treatment could distinguish the distress trajectories. Mastery was the only unique predictor. Most patients were not distressed in response to breast cancer or only temporarily so. Yet, a minority of patients became or remained distressed after the end of treatment.
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Background: In many healthcare systems, treatment recommendations for cancer patients are formulated by multidisciplinary tumor boards (MTBs). Evidence suggests that interdisciplinary contributions to case reviews in the meetings are unequal and information-sharing suboptimal, with biomedical information dominating over information on patient comorbidities and psychosocial factors. This study aimed to evaluate how different elements of the decision process affect the teams' ability to reach a decision on first case review. Methods: This was an observational quantitative assessment of 1045 case reviews from 2010 to 2014 in cancer MTBs using a validated tool, the Metric for the Observation of Decision-making. This tool allows evaluation of the quality of information presentation (case history, radiological, pathological, and psychosocial information, comorbidities, and patient views), and contribution to discussion by individual core specialties (surgeons, oncologists, radiologists, pathologists, and specialist cancer nurses). The teams' ability to reach a decision was a dichotomous outcome variable (yes/no). Results: Using multiple logistic regression analysis, the significant positive predictors of the teams' ability to reach a decision were patient psychosocial information (odds ratio [OR] 1.35) and the inputs of surgeons (OR 1.62), radiologists (OR 1.48), pathologists (OR 1.23), and oncologists (OR 1.13). The significant negative predictors were patient comorbidity information (OR 0.83) and nursing inputs (OR 0.87). Conclusions: Multidisciplinary inputs into case reviews and patient psychosocial information stimulate decision making, thereby reinforcing the role of MTBs in cancer care in processing such information. Information on patients' comorbidities, as well as nursing inputs, make decision making harder, possibly indicating that a case is complex and requires more detailed review. Research should further define case complexity and determine ways to better integrate patient psychosocial information into decision making.
Article
Background: Cancer is a complex health problem requiring multidisciplinary care. There are clinical guidelines available in order to improve the process and outcomes of cancer care within Europe. However, strategic action is still needed in many European Union (EU) Member States to develop or improve national cancer control plans (NCCPs), which play a key role in cancer control and care. The current study clarifies the extent of implementation of psychosocial oncology care (PSOC) in the EU. Method: A survey methodology was used to cover four dimensions: (1) inclusion of PSOC in NCCPs; (2) structure and resources of PSOC delivery; (3) use of NCCP clinical guidelines; and (4) education and training resources available along with determination of training needs in PSOC. Results: Twenty-seven (90%) countries returned questionnaires of which 21 (78%) include PSOC in their NCCP. However, only 10 (37%) reported having specific budgets for PSOC, 8 (30%) having nationally recommended PSOC clinical guidelines, and 6 countries (22%) reported having an official certification for PSOC education. Conclusion: Although many countries seem to have integrated PSOC into their NCCP, there is still much to do in terms of allocating resources and delivering psychosocial care equitably. Also, there is a need for improving training and certification in PSOC. The findings indicate the need to develop national policies concerning PSOC with clear targets for deliverables in an appropriate timetable in order that psychosocial services and existing clinical guidelines are implemented and fully integrated into EU NCCPs. Copyright © 2015 John Wiley & Sons, Ltd.
Article
Background: Modern management of Oesophageal and oesophagogastric junction (OGJ) cancers requires a multidisciplinary approach, which was implemented at our health centre in 2005. This study aimed to assess the impact of this change on clinical outcomes. Methods: A retrospective cohort study was conducted, covering all patients treated for oesophageal and OGJ cancer at the cancer centre established by the Bellvitge University Hospital and Catalonian Institute of Oncology, over two time periods, i.e. 2000-2004 and 2005-2008. Descriptive and multivariate analyses were performed using survival at 1 and 3 years as dependent variables. Results: Between 1 January 2000 and 31 December 2008, 586 patients were included. Number of patients with unknown stage at diagnosis was significantly reduced. Preoperative strategies at the oesophageal location clearly increased in the recent period. A multidisciplinary approach resulted in a significant reduction in surgical mortality (11.8 vs. 2 %) in the period 2005-2008. Analysis restricted to patients undergoing surgery with curative intent indicated a significant increase in 1- and 3-year survival in the latter period (68.4 vs. 89.8 and 38.2 vs. 57.1 %, respectively). Multivariate analysis showed that variables associated with improved survival were: age; tumour stage; radical intent of treatment (surgery and radical combined chemoradiotherapy); and therapeutic strategy. Conclusion: Better selection of patients for therapy together with improved staging resulted in a significant improvement in 1- and 3-year survival in cases undergoing surgery with curative intent. These changes would support the adoption of a multidisciplinary approach to clinical decision-making in cases of oesophageal and OGJ cancer.
Article
Background and objective The main objective of this study was to determine the prevalence and the predictors of mental disorders in cancer patients. Patients and method 400 ambulatory cancer patients were included in the study. All the patients with a score of 14 or higher in the Hospital Anxiety and Depression Scale (HADS) received a structured clinical interview (SCID-I. DSMIV) with the objective of determining the prevalence of mental disorders. Results 24% cancer patients had criteria for a mental disorder. The predictors of mental disorders were radiotherapy treatment, psychopharmacological treatment and pain. Conclusions These results support the need to assess the possible anxious and depres-sive symptoms during cancer treatment and follow up. The predictors found can help to detect possible psychiatric cases in cancer patients.
Article
Objective: The purpose of this study was to assess psychosocial changes at two particular moments: at cancer diagnosis and 2-4 weeks after having finished treatment. Material and methods: A total of 67 cancer outpatients were assessed in this study. The inclusion/exclusion criteria were as follows: ambulatory cancer patients aged 18 years or older and receiving medical treatment. Patients with a performance status <50 or with cognitive impairment (≥3 errors in the Pfeiffer Questionnaire) were excluded. The inclusion period ranged from 1 April 2005 to 30 April 2007. The scales used were the 14-item Hospital Anxiety and Depression Scale (HADS), which has two subscales for anxiety (seven items) and for depression (seven items), the Quality of Life Short Form 36 Questionnaire, the Mental Adjustment Scale and the Medical Outcomes Study Questionnaire for measuring social support. All data were compared with sociodemographic and medical characteristics. Results: Patients had higher levels of pre-treatment versus post-treatment anxiety (HADS-Anxiety mean, 7.41 versus 6.69), whereas depression scores were higher post-treatment versus pre-treatment (HADS-Depression mean, 3.14 versus 3.89). After medical treatment, patients were more fatigued, with lower performance status (Karnofsky Index), less social support and less quality of life, but no differences in coping styles were found. Women had higher levels of anxiety than men. Patients with psychiatric antecedents had higher levels of distress, but these differences were only observed after diagnosis and not after the treatment. In general, head and neck cancer patients had higher levels of distress, worse coping and worse social functioning. Conclusions: Cancer patients require special consideration before and after treatment. Anxiety is the symptom that characterizes diagnosis, whereas depression is more common after medical treatment. The head and neck cancer patients were the group with the highest complexity.
Article
The purpose of this study was to assess the psychological care needs of cancer patients throughout the healthcare process: after diagnosis, after medical treatment (surgery, chemotherapy, radiotherapy) and during follow-up. A total of 703 ambulatory cancer patients were assessed in this study. The inclusion period was from April 1, 2005 to April 30, 2007. The first psychological scales used were the 14-item Hospital Anxiety and Depression Scales (HADS), which has two sub-scales for anxiety (7 items) and for depression (7 items). All patients with a score ≥ 14 were assessed through the Structured Clinical Interview for Psychiatric Disorder (SCID-I) of the DSM-IV. All data were compared with sociodemographic and medical characteristics. Of the 703 cancer patients in the study, 349 were men and 354 women, with a mean age of 53 years. The median time between the cancer diagnosis and our clinical interview was 6 months (range, 12 days to 190 months). Overall, the screening tools indicated that one in four patients needed psychological care. The most common psychiatric diagnosis was adjustment disorder (129 cases), whereas 10 patients were diagnosed with major depression. Using a HADS cut-off score of > 7 for anxiety and depression, 28% and 17% of patients, respectively, were classified as "possible clinical cases." Risk factors for distress included age < 65 years, asthenia, constipation, and a low performance status. However, chemotherapy treatment was found to be a protector against distress in cancer patients. Chemotherapy treatment is interpreted by the patients as a protector against cancer, thereby reducing distress levels.
Article
The burden of cancer in the worldwide context continues to grow, as incidence and mortality increase each year. Regardless of where they live, a significant proportion of cancer patients at all stages of the disease trajectory will suffer social, emotional and psychological morbidity as a result of their diagnosis and treatment. Psychosocial interventions have proven efficacious in helping patients and families overcome many of the challenges that arise consequent to a cancer diagnosis. Addressing psychosocial needs is an essential aspect of any model of adequate cancer care, however it may also prove to be a cornerstone in efforts to extend the reach of cost-effective cancer treatment to meet the growing global need. In order to set the stage for discussion of economic issues, this paper first briefly reviews the literature detailing the extent of distress and the efficacy of psychosocial treatments for cancer patients. This is followed by a summary of terminology and costing concepts in the economic evaluation of psychosocial treatments, and a review of the literature on medical cost offset in mental health, other medical populations, and in cancer patients. The literature clearly supports the notion that psychosocial interventions are not only effective, but also economical. Conclusions support adding costing data into evaluations of the efficacy of psychosocial treatments in order to detail the often present but usually overlooked long-term cost savings that may be accrued to overburdened health-care systems.
Article
Clinical practice guidelines are increasingly being developed in medical settings to provide evidence-based recommendations to guide the clinical care of patients. The development of Clinical practice guidelines for the psychosocial care of patients with medical illness is a newer initiative, and more complex as the target audience includes health care professionals from diverse backgrounds. In Australia, the National Breast Cancer Centre and National Cancer Control Initiative have collaborated to develop Clinical practice guidelines for the psychosocial care of adults with cancer, funded by the Australian Government Department of Health and Ageing. This paper outlines the development of these guidelines in the international context, gives an overview of their content, and describes strategies for their implementation and evaluation.
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